New Breast Cancer Guidelines Could "Devastate" Black Women

Since the U.S. Preventive Services Task Force (USPST) announced its breast cancer screening guidelines, women of all races have expressed confusion and concern. But perhaps even more than others, one group has particular cause to be wary: Black women.

After reviewing data and weighing the potential risks of mammography against the benefits, the USPST now recommends that women begin getting regular mammograms at age 50 rather than at 40, and that the frequency be reduced from annual to once every two years. So what does this sweeping change in policy mean for Black women — who have the highest breast cancer death rate of any race, are at increased risk for developing the disease at younger ages, and are disproportionately prone to an extremely aggressive form of breast cancer?

“These new recommendations could have a devastating effect on African-American women,” said Marisa Weiss, M.D., director of Breast Radiation Oncology and director of Breast Health Outreach at Pennsylvania’s Lankenau Hospital.

Weiss, who is also the founder of leading online resource breastcancer.org, believes that given the unique impact of the illness on black women, the USPST’s recommendations could prove disproportionately harmful.

“African-American women are more likely to get breast cancer than white women when they’re under age 40,” she said.

Indeed, the U.S. Department of Health reports that Black women ages 35 to 44 have a breast cancer death rate more than twice that of white women in the same age group.

“These guidelines that would start screening at age 50 would pass over the time of greatest risk for African-American women,” said Weiss.

But age doesn’t pose the only problem — the particular type of breast cancer many black women are diagnosed with brings its own set of serious concerns.

“Plenty of African-American women get regular old breast cancer that looks like white women’s breast cancer,” Weiss said. But nearly one-third of breast cancers diagnosed in Black women are an especially aggressive and fast-developing type called “triple negative,” which is resistant to traditional forms of treatment.

“When it comes to triple negative breast cancer, it’s a kind of ‘interval cancer’ that can sneak up in the time between mammograms,” said Weiss. “By the time you find it by feeling it or finding it at a significant size, it’s not stage 1 anymore.”

Since the USPST recommends not only delaying the age at which women begin receiving mammograms, but also decreasing their frequency to once every two years, the consequent lags in diagnosis could prove dangerous.

Black women already receive fewer mammograms than white women. Evidence has also shown that even after receiving breast cancer screenings, black women are less likely to understand or even receive their results, and to obtain necessary follow-up testing and care. When they are diagnosed, it is frequently with later stages of the disease than women of other races.

Both the American Cancer Society and the Susan G. Komen breast cancer advocacy foundation have issued statements in response to the government’s new guidelines, saying they have reviewed the same data as the USPST and still believe women should follow the old recommendations. Weiss agreed.

“Mammography is not perfect of course. It’s got faults,” she said. “But I strongly recommend starting mammogram screening at age 40 every year.”

Weiss advises that women who have a history of breast cancer in their family speak to their doctors about beginning screenings early. However, she warns, all women should be vigilant.

“80% of women who get breast cancer don’t really have a family history, but they think, ‘It’s not in my family, so I don’t have to worry about it,’” she said. “If you feel lump or an abnormality, if something’s not right, that’s another reason to start screening earlier.”